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Eye On Index

Caithness And Sutherland Maternity Action Team

Report of Inaugural Meeting held on Friday, 11 February 2005 at 1400 hrs in the Conference Room at Caithness General Hospital, Wick.

David Alston, Joint Chairman
George Bruce, Joint Chairman
Dr Iain Johnston, Clinical Director
Sheena Craig, General Manager
Pauline Craw, Assistant General Manager
David Flear, Area Convenor
Georgia Haire, Assistant General Manager
Mr Paul Fisher, Lead Clinician
Dr Russell Lees, Cons Obstetrician/Gynaecologist
Dr John MacLeod, Cons Anaesthetist
Gill Keel, Head of Public Involvement Cameron Stark, Cons in Public Health
Noelle O’Neill, Clinical Effectiveness Co-ordinator
Bill Fernie, Councillor
Sandra McInnes, Comm Nurse/Midwife, Sutherland
Aelex Miller, North Action Group
Helen Bryers, Senior Midwife
Alan Miller, Scottish Ambulance Service
Carol Buxton, Caithness & Sutherland Enterprise
Pam McBeath, Comm Midwife, Caithness
Fiona Murdoch, Staff Midwife

Dr Alison Graham, Medical Director Nigel Hobson, Associate Director of Nursing
Joanne MacNicol, Acting Nurse Manager
In Attendance: Alison Sinclair, Personal Assistant

1. Welcome and Introductions

David Alston welcomed everyone to the meeting. He advised that after discussion with George Bruce, they would be chairing the meetings alternatively with David starting today. Introductions were made around the table.

2. Working Together
David asked that everyone involved in the next stages of work be open and honest, and that everyone involved should feel able to contribute freely. The Action Team has to go through the process to reach its conclusions and recommendations. It was stated that all members of the Action Team need to work together to get the required information, however, individual Team members do not have to commit themselves to support the final outcomes.Gill Keel then proceeded to give a quick summary of the principles as detailed in the Project Initiation Document (PID), as follows· Agree to work to the list of principles· Value each others contributions· Not to be hidden from the public, they must always feel they know what is going on· Share openly any expertise· Respect for each other· Ensuring systems are in place for clarity and advice· Promoting good communication to the wider local communities. The consensus was that the principles were very clear and precise. If anyone had any matters or concerns to bring them up with the Joint Chairmen or the Project Manager when in post.Iain Johnston (IJ) asked DA for a definition of “corporate responsibility for the delivery of this” as not everyone may have an understanding of this terminology (under section 4 – “Principles against which the project will be measured” (page 4). DA agreed that a definition would be helpful and stated that “corporacy” is about the Action Team having shared ownership of the process and taking joint responsibility for the outputs. Again it relates to the spirit of honesty and openness that should be adopted through the process, and about valuing each others contributions even when opinions differ.

3. The Role and Remit of the Maternity Action Team
The Chairman asked Gill to outline re the Board’s Objective for the Maternity Action Team and what the decision making process would be.· Gill advised that Section 2 of the Project Initiation Document was lifted from the Highland NHS Board papers (December 2004). The Objective is to develop a work plan which then can be taken to the North Highland Community Health Partnership who will then take their conclusions and recommendations to the NHS Board. The four stated decision making criteria of the NHS Highland Board are detailed in the PID. The Action Team felt it would be useful to attach the relevant NHS Board paper to the PID.§ David Flear (DF) questioned whether an additional decision making criterion should be added to the Objectives stated on Page 2 specifically an element of “acceptability to the community”. However DA informed the Team that the four objectives stated were those agreed by Highland NHS Board and, therefore, it was the Team’s remit to work to these. However, it was agreed that in working towards outcomes, the Action Team should have regard to the acceptability of the proposed solution to the community, and that this point would be included in the PID.· It was recognised that there is a lot of work to be completed, and that the original timescale in the PID may not be achievable. GK/NO’N

4. The Project Initiation Document
DA asked Gill Keel (GK) to talk through the PID. GK took the Action Team through the document explaining the rationale and content of each section. DA asked the Action Team for comments and emphasised that any concerns relating to the PID should be highlighted.· Carol (CB) felt that the process should be about developing the Caithness model, rather than its implementation and DA agreed with this point.· DA asked the Action Team if the outcomes of 7 tasks, as stated in section 3, were acceptable. This was agreed. Tasks 5 and 7 (developing primary care/public health and resource framework) would need to be fed into the process at a later stage ie. once the clinical sub groups had reported. · The interdependency between tasks was noted and the Action Team felt that one of the key roles of the Project Manager would be to ensure systematic and regular cross-checking between the streams of work and managing feedback from all the sub-groups.· Of the 7 task sets, after discussion it was decided that “Primary Care & Public Health” and “Resource Framework” would be taken on board at a later date. Also that for the “Transport and Accommodation” task that another group in NHS Highland are looking at the Scottish Ambulance Service but locally we need to look at all the issues· Mr Fisher informed the Action Team that recruitment to a CGH General Surgeon vacancy is in progress. The Job Description does not include Obstetrics as it may be unrealistic to expect candidates to have this experience, and it is vital to attract as much interest as possible, recognising that rural posts are difficult to fill at the best of times. However, Paul stated that at interview, they would explore the potential for involvement in Obstetric/Gynaecology emergency care. The Action Team agreed with the aim of stabilising the surgical service as an immediate priority.· The potential input from GPs into maternity services was discussed briefly, but Iain Johnston indicated strongly that there would be minimal interest from local GPs at present.· David Flear asked why the Project Initiation Document did not refer to the Socio Economic impact report. After discussion it was agreed that this is implicit in the PID. Gill stated that the objective for the Action Team was to explore the many clinical and professional factors which will ultimately shape the possibilities for a Caithness service. The CHP and NHS Board will then consider the Action Team’s recommendations in context of the wider community impacts.· Amendments to the Project Initiation Document as follows:· Section 3, outcomes – add reference to community acceptability· Section 5, para 1 - insert clinical services and staff· Section 5 - add reference to Recruitment and Retention · Section 5 1– change ”new service” to outline model · Section 5 6 –add reference to additional support, and costs of accommodation· Membership – It was agreed to invite 2 reps from THC – 1 from Caithness, 1 from Sutherland (see note under sub groups) The Action Team agreed to the Project Initiation Document subject to the above amendments. GK / NO’N

5. The Project Manager + Job Description
The Action Team was informed by Sheena Craig (SC) that the interview for this post is to be re-scheduled. Four individuals had expressed an interest in the post. However, 2 withdrew their application and 1 was unable to attend interview on the scheduled date. The Action Team felt that the role of the project Manager is critical to the successful implementation of this process and that it was essential to get the right person. SC and PC will organise the re-scheduling of the interviews. If no one is appointed to the post it will be put to external advert locally.The Job description was agreed. SC/PC

6. Sub groups
The Action Team agreed it was essential to identify the membership and a professional lead for each sub-group immediately. Other aspects to consider for all of the sub-groups should be (a) the level of financial support available to facilitate the direct involvement of local women, and (b) the venue and timing of the meetings, balancing the different needs of staff and local women/community members. The composition of each sub group is considered below in the order they appear in the PID.The ideal number for an effective sub group was agreed as approximately 8 to 10 members. David Alston suggested that the two Chairmen would attend some of the sub-group meetings, and would require to be kept informed of the work plans and meetings of each sub group. David Flear stated that Cllr Alison McGee had requested that Cllr Rita Finlayson be on the Action Team. This was agreed - invitation to be sent by joint Chairmen.It was agreed to invite representation from the locum Obstetric staff. It was also agreed that those involved in either the core Action Team or any of the sub groups would be authorised to arrange a substitute if unable to attend. The tasks were grouped, and 4 sub groups agreed as follows:-· Sub-Group - Midwifery Lead – Pauline Craw Pauline will be supported by Helen Bryers, Midwifery Officer for NHS Highland. Membership - Midwives - Julie Munro, Midwife Sister, CGH, Staff Midwife Fiona Murdoch, Comm Midwife Pam McBeath, Comm Midwife Sandra McInnes. Two service users/potential service users to be identified (see note below re development time).· Sub Group - Obstetrics and GynaecologyLead – Dr Russell LeesAgreed to combine both elements into one sub group.Membership – Russell to be the link with the other Consultants based in Raigmore, and the locally based locum staff. Locum staff will be involved directly. Staff Midwife Avril Andrew. Theatre Staff.  Two user/potential service users. It was suggested that when meetings are held the agenda is split into the two specialities and run sequentially.· Sub Group - CGH Clinical Departments and Specialties Lead – Dr Iain JohnstonMembership - Mr Paul Fisher – General Surgeon. Dr John MacLeod – Anaesthetist. Still to be identified - theatre staff, A & E staff, Bignold Wing staff, Henderson Wing staff.  Two user/potential service users.· Sub Group - Social FactorsLead – Sandra McCaughey (CASE)Discussed the Highland-wide work in progress on transport and non-clinical accommodation, into which this sub-group will feed local issues.Membership - Georgia Haire. Alan Miller (SAS). Social Worker (Bill Fernie to speak to Bob Silverwood re nomination) plus 2 user representatives.The actions identified under task sets 5 and 7 of the PID will be progressed through the CHP once the sub groups have made sufficient progress. Cameron offered Public Health support to each of the sub group. DA/GBSCAllPCDARIJSMcCBF

7. Action Planning
See attached Action Plan

8. Development Time
Lynn Marsland (LM), Head of Learning and Organisational Development, has offered assistance with carrying out some work around supporting team behaviours to ensure effective involvement of everyone who has a part to play, and to keep the process constructive. LM has provided GK with dates her team would be available. GK to provide these dates to Alison Sinclair (AS). One of the aims of the development time would be to assist the women in selecting who and how they become involved. It was agreed that there would be 3 representatives on the Maternity Action Team from the Users Group ie 1 from Maternity, 1 from Gynaecology, and 1 from an Ethnic Minority community if possible. GK / LM

Press Information

IJ asked clarification from the Chairman as to the Action Team’s position in communicating with the Press. It was agreed that DA and GB jointly will communicate with the Press on behalf of the Action Team. DA / GB

Date of Next Meeting
To be confirmed (but no later than) mid-March 2005.